Provider Demographics
NPI:1396852232
Name:LAURIN, JENNIFER R (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LAURIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 EAST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5372
Mailing Address - Country:US
Mailing Address - Phone:413-464-2512
Mailing Address - Fax:413-443-1975
Practice Address - Street 1:1450 EAST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5372
Practice Address - Country:US
Practice Address - Phone:413-464-2512
Practice Address - Fax:413-443-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69712Medicare ID - Type Unspecified